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Thorax - 2

Thoracic Examination

Subjective -History -OPQRSTU -Review any scans (x-ray, MRI) -Systems review
Thoracic scan -Observation -AROM, PROM w/ OP Resistive -Compression -Traction -Shoulder girdle -Sensation -Reflexes -UMN -Rib Spring
Functional Testing: looking for the driver in functional task - Cervical Rot - Thoracic Rot - Forward bend - Backward bend
Ortho exam: Observation - Scapular Alignment - Smoothness of T curve - Degree of kyphosis - Chest wall shape - Breathing - Ms bulk symmetry - Lesions, scars, swelling
Ortho exam: Palpation - Ms Tone Palpation - Functional unit/Ring palpation and wiggle
Ortho exam: AROM/PROM - General: Flex (20-45), Ext (15-20), SB (25-45), Rot(35-50) (scan) - Combined motion testing: Quadrant SB/Ext, SB/Flex, Latexion, Rotexion - Segmental (Seated): Positional testing (type II dysfunction FRS, ERS)
Latexion vs Rotexion Latexion: begin with SB then add contralat Rot Rotexion: begin with Rot then add ipsilat SB
Positional testing - Palpate the TPs: Left T6, Right T7 - Check in: Neutral, Flex, Ext
PIVM assessment: Flex - Have pt flex - Note the SP - Can apply OP to SP to feel for end range
PIVM assessment: Ext - Have pt Ext and note space b/w SP - Can look at T1-4 via head and T-S mvt - B arm raise
Assessment strategy - Center your body - Relax, perform self body scan to set neutral - Find a center line outside your body - The assessment is about your pt's asymmetry not yours - Use wt shift and leverage to move your pt
PAIVM assessments done in prone (5) - Facet superior - Facet inferior - Costotransverse superior or PMS - Costotransverse inferior or ALI - Lateral translation (functional unit translation)
Accessory motion tests/assessments - PAIVM (arthrokinematic function) - PA assessment - Rib spring test (prone & supine) - Stress tests
PAIVM assessment - Assess neutral zone: neutral zone wiggle - Continue to elastic zone, assess end feel - Glide may be: Boggy: a sluggish feel Compressed (excessive force closure) Fixation jt block Hypermobile Hypomobile (fibrous leathery end feel)
Facet Superior glide PAIVM - Stabilize contralat TP - Apply sup/ant glide of facet (45–60 degree angle)
Facet Inferior glide PAIVM - Stabilize inf facet - Apply an inf glide
Costotransverse Superior glide (vertebral sternal) PAIVM - Stabilize TP superiorly - Apply sup glide to rib
Costotransverse Inferior glide (Vertebral sternal) PAIVM - Stabilize TP inferiorly - Apply inf glide to rib
ALI glide - Stabilize TP - Apply diagonal glide: ant/lat/inf direction
PMS vertebral chondral glide - Stabilize TP - Apply diagonal glide: post/med/sup direction
Assessing 1st rib in supine - Stabilize contralat TP - Find rib tubercle, apply inf glide
Stress test: costotransverse jt - Stabilize contralat TPs of level above and same level - Apply ant stress to rib
3 Special tests - Prone Arm Lift (PAL) - Seated Arm Lift (SAL) - Rib Expansion (1-3 inches)
Neuro-dynamic assessment Slump and dural differentiation
Sagittal Plane Thoracic Step 1: Functionally move area to be assessed - Upper T Flex/Ext (Pivot T2-4) - Lower T Flex/Ext (Pivot T 8-10)
Sagittal Plane Thoracic Step 2: Coordination/dissociation Elongate posture and maintain with UE Flex/Ext
Sagittal Plane Thoracic Step 3: Ms assessment Ms t/o range: - Supine/Prone Upper/Lower T Flex/Ext t/o range (all combos) Stabilization: - Isometric hold: Seated Flexor & Extensor hold (manual assessment) - Seated T set and B UE Flex/Ext against resistance. Ext give=lower T, Flex give=upper T
Lateral Thoracic Agonist/Antagonist - Agonist: Lat Flexors - Antagonist: Contralat Lat Flexors
Lateral Thoracic Step 1: Functionally move area to be assessed - Seated SB (even curve, no hinge or deviation)
Lateral Thoracic Step 2: Coordination/dissociation Elongate posture and maintain with unilat UE Abd
Lateral Thoracic Step 3: Muscle assessment Ms t/o range: - S/L side curl t/o range Stabilization: - Isometric hold: Seated lat isometric hold (manual assessment) - Or side plank - Seated T set and unilat UE Abd against resistance
Thoracic Rot Step 1: Functionally move area to be assessed - Seated T Rot (even twist, hinge or deviation) - Even curve, No SB, No Flex/Ext
Thoracic Rot Step 2: Coordination/dissociation Elongate posture and maintain with unilat UE horizontal Abd
Thoracic Rot Step 3: Muscle assessment Muscle t/o range: - Seated Rot t/o range Stabilization: - Isometric hold: Seated Rot, isometric hold (manual assessment), or 4 point unilat reach - Seated T set and unilat UE horizontal Abd against resistance
Stabilization Assessment: T hold with UE motion - If Ext “give” -> deficient ant mms - If Flex “give” -> deficient post mms (more likely upper T) - If Lat bending “give” -> deficient lat mms (will look like scoliosis_ - If Rot “give” -> deficient rotator mms
Classification & Pattern Recognition - Excessive force closure - Reduced or insufficient force closure - Form closure issue, used to be called clinical instability (clinically unsound segment)
Created by: neej